In This Issue of Archives of Internal MedicineFREE

COLLABORATIVE CARE INTERVENTION FOR STABLE ISCHEMIC HEART DISEASE

Collaborative care models have been shown to improve care and outcomes for patients with chronic conditions such as diabetes and depression. A total of 703 patients with ischemic heart disease from 4 Department of Veterans Affairs facilities and affiliated clinics, whose angina was poorly controlled, were enrolled a prospective, population-based, cluster-randomized (by primary care provider) trial of a multifaceted intervention based on a collaborative care model. Collaborative care teams transmitted recommendations via the electronic health record to 183 primary care providers. Although 92% of 701 recommendations were implemented, patients' self-reported symptoms and health did not significantly improve and concordance with guidelines improved only modestly.

Creative, cost-effective interventions to improve the quality of care of chronic illnesses are needed. Published evidence suggests improvements occur by incorporating pharmacists into the team-based management of patients with diabetes. Remotely located pharmacists armed with population management tools and electronic medical record connectivity can effectively collaborate with physicians electronically and manage patients telephonically. This method of providing care offers several benefits over the traditional in-clinic, team-based care.

Cardiac resynchronization therapy (CRT) with biventricular pacemakers are known to be effective in reducing clinical events in patients with systolic heart failure with prolonged QRS. This meta-analysis of randomized clinical trials enrolling 5813 patients reports that the reduction in clinical events is limited to patients with severely prolonged QRS (ie, >150 milliseconds [ms], 40% relative risk reduction; P < .001), with no benefit in the those with a moderately prolonged QRS (ie, 120-150 ms, risk ratio, 0.95 [95% CI, 0.82-1.10]; P = .49). These findings can have implications for the selection of patients for CRT.

PROSPECTIVE EVALUATION OF ANALGESIC USE AND RISK OF RENAL CELL CANCER

Epidemiologic data suggest that analgesic use increases the risk of renal cell cancer (RCC), but few prospective studies exist. Cho et al investigated use of analgesics in relation to RCC risk in large prospective studies of women and men. Regular use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an increased RCC risk. There was a dose-response relation between duration of regular nonaspirin NSAIDs use and RCC risk with up to about 3-fold elevated risk among those who used for 10-years or longer. The authors conclude that longer duration of use of nonaspirin NSAIDs may increase the risk of RCC.

COMMUNICATING UNCERTAINTIES ABOUT PRESCRIPTION DRUGS TO THE PUBLIC

Schwartz and Woloshin surveyed a nationally representative sample of 2944 American adults to assess their understanding of the meaning of Food and Drug Administration (FDA) approval and conducted a randomized trial to test the effect of brief explanations (<40 words) communicating drug uncertainties on consumer choices. The authors found that a substantial proportion of the public mistakenly believes that the FDA only approves extremely effective drugs (39%) that lack serious adverse effects (25%). Participants randomized to explanations were more likely to correctly choose a cholesterol drug known to reduce myocardial infarctions over one only known to lower cholesterol levels (71% vs 59%) and an older rather than newly approved heartburn drug (53% vs 34%).

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